TWO senior bureaucrats have been stood down after ''telling the minister what they thought he wanted to hear'' before 700 students with disabilities were left stranded without transport to school last week.

The officers were stood down without pay from their positions yesterday pending disciplinary action under the Public Service Employment Management Act.

The Premier, Barry O'Farrell, commissioned the former director general of education, Ken Boston, to conduct a review of what went wrong in the delivery of the Assisted School Travel Program, promising those to blame would be disciplined.

In his report, Dr Boston, who has also headed England's curriculum authority, criticised the deputy director-general, finance and infrastructure, Hugo Harmstorf, and the director of finance shared services, Ian Anderson, for failing to deliver the $80 million program to the most vulnerable children in NSW.

He recommended director-general for education, Michele Bruniges, consider disciplinary action against the two bureaucrats, which she has enforced.

''They have damaged the reputation of the Department of Education and Communities in the opinion of the transport operators, the community and the NSW government,'' Dr Boston said.

''They have been adrift from their people. They have no performance agreements in place between themselves and their subordinate officers.

''They have failed to establish adequate processes to assess regularly and comprehensively the risks associated with the AST program.''

Dr Boston said both men have been in their positions for little more than 12 months and Mr Harmstorf had been acting in his role for much of that time. ''But I do not consider that to diminish their responsibility,'' he said.

The report came as a relief to the Education Minister, Adrian Piccoli, who has faced criticism for allowing the transport crisis to arise on the first week back at school.

The Boston report said Mr Piccoli received a formal briefing on ''back-to-school issues'' on December 6, including an update on the assisted school-travel program.

The briefing noted the service was at risk and advised that an extra expression-of-interest round be conducted to attract additional transport operators.

The Boston report said no mention was made in the briefing of any risk of transport operators refusing to accept transport runs due to a new schedule of rates.

Nor was any mention made in further briefings to the minister on December 17, January 17 and January 24.

The Opposition Leader, John Robertson, said Labor would call for an upper house inquiry into the minister's handling of the transport scheme to find a permanent solution.

The Boston report mentioned that a briefing paper, known as a ''house note'', which signals controversial issues that may arise in parliament, should have rung alarm bells with Mr Piccoli.

The note was last revised in November last year.

Mr Robertson accused the government of making ''scapegoats'' of the two bureaucrats, saying the blame lay with Mr Piccoli, who failed to ask enough questions to ensure the service would be delivered.

The Greens NSW MP John Kaye said Mr Piccoli had ''dodged a bullet''.

''While several bureaucrats have been landed with the lion's share of the blame, the minister should have ensured that the processes worked and the state's most vulnerable kids were not left stranded,'' Dr Kaye said.

Dr Bruniges yesterday appointed a former deputy director-general of the NSW Department of Premier and Cabinet, Chris Raper, to implement the Boston report's findings into the Assisted School Travel Program.

As President Barack Obama considered a decision on birth control that would turn into an unexpected political nightmare, he heard it from inside and outside his White House: He risked a fierce backlash if he required religious employers to provide insurance coverage for contraception in violation of their beliefs.

Over the course of months, Catholic groups and officials spoke with White House aides, sent letters and wrote opinion columns. Vice President Joe Biden and Obama's then-chief of staff, Bill Daley, both Catholics, and other top administration officials spoke of the need to be aware of the consequences, given how Catholic groups would view the decision and how it would affect them.

But the president was hearing from the other side, too. Women's health advocates and their allies inside the White House were adamant about the importance of making free contraception available to all women; to them, it was a matter of health and fairness. Democratic senators and senior advisers joined in.

In the end, that's where Obama came down.

What came next evidently surprised the White House.

There were furious protests from Catholic groups, including administration allies. Republicans and even some Democrats were outraged.

The rising furor threatened to overwhelm the president's message and affect his re-election hopes. With no sign of the firestorm abating, Obama announced a hasty and embarrassing backtrack Friday.

"This is an issue where people of good will on both sides of the debate have been sorting through some very complicated questions to find a solution that works for everyone. With today's announcement, we've done that," Obama said. "Religious liberty will be protected, and a law that requires free preventive care will not discriminate against women."

Under the approach, employees at church-affiliated institutions such as Catholic hospitals or charities still could get free birth control coverage, but it would come directly from their health insurer. Employers would not provide or pay for it.

This solution soothed some concerns from religious groups while keeping women's groups satisfied.

So why wasn't this approach taken in the first place?

Similar solutions had been advocated to the White House for months.

According to a senior administration official, some approaches were considered and rejected as unworkable, but what came out Friday simply hadn't occurred to administration officials weeks earlier.

Back then, administration officials perhaps didn't feel the same sense of urgency, according to the official, who said the policy process could have been stronger. The official insisted on anonymity to discuss internal deliberations.

To many, it seemed a needlessly self-inflicted wound for a president known for taking a politically cautious approach. The White House insisted Obama was attuned to the concerns of religious employers, especially since he had worked with Catholic parishes early in his career in Chicago, and that he intended to address those concerns in time.

But to some Catholics it appeared the administration failed to understand their concerns and how the decision would resonate.

"Lord knows we tried" to warn the administration, said Simone Campbell, executive director of Network, a Catholic social justice lobby.

Campbell said the administration seemed focused on the health issues involved in putting Obama's health care law in place. "Even though a bunch of us weighed in and said there was this other layer of concern, it's like above where they ordinarily focus, so it just didn't compute," Campbell said.

"I don't think they fully understood the religious liberty side and I certainly don't think they understood just how it would be received by Catholics," said Stephen Schneck, a political scientist at the Catholic University of America.

They soon would find out.

The administration announced the original policy on Jan. 20.

Within hours, the U.S. Conference of Catholic Bishops called it an affront to religious liberty and urged Catholics to tell their elected leaders to rescind it. Cardinal-designate Timothy Dolan of New York, the conference's president, appeared in a Web video to accuse the administration of being "on the wrong side of the Constitution."

About a week later, priests read letters from bishops in churches across the nation, expressing their concerns.

Republicans soon pounced. GOP presidential candidates Mitt Romney and Newt Gingrich accused the president of an attack on religion. Congressional Republicans announced plans to overturn the policy.

The White House began hearing from generally supportive outsiders as well.

Commentators such as E.J. Dionne and Mark Shields jumped on Obama for displaying a tin ear to Catholic concerns.

Former Indiana congressman and ambassador Tim Roemer and other moderate Democrats spoke out. Among the organizations that mobilized was Democrats for Life of America.

"It became apparent that this was not going to be something that was just going to lose steam," said Kristen Day, the group's executive director. "The ranks were actually increasing rather than decreasing."

Former Rep. Bart Stupak, D-Mich., said he and Roemer offered the perspective of two lawmakers who had represented conservative Democratic districts.

Stupak said he wondered, "Why would you pick this fight in an election year? In any year, to tell you the truth."

"At first they were sort of cool: 'We know what we're doing, we'll get it resolved,'" Stupak said of the White House. "Toward the end, in the last week, it was more like, 'We're working on it, we've heard you. We'll get this thing behind us.'"

Several Democrats broke publicly with the president. Former Virginia Gov. Tim Kaine, a recent chairman of the Democratic National Committee, said the White House "made a bad decision."

Even as pressure mounted, Democrats supporting access to contraceptives pushed to make sure the White House didn't retreat.

For New Hampshire Sen. Jeanne Shaheen and other Democratic women in the Senate, their last opportunity to make their case came Wednesday, when the president took his motorcade to Nationals Stadium in Washington to meet with Senate Democrats.

Obama offered no hint an announcement was two days away, but under questioning he offered an assurance.

"He said to all of us that he was committed to the principle that women should have access to that contraceptive coverage," Shaheen said.

That same day, administration officials including senior adviser Valerie Jarrett and the first lady's chief of staff, Tina Tchen, convened a meeting with women's groups at the White House to urge more women to speak out in support of the president's decision, a Democratic official said.

Participants discussed reframing the debate as less about the Catholic Church and more about a war on women, the official said, insisting on anonymity to discuss the private meeting.

By then it was already becoming clear that Obama would have to change course. Some 48 hours later, he stepped before the microphones in the White House briefing room to announce that he was.

THE Hunter public will have to lobby the state government for the millions of dollars it would cost to implement the changes recommended in a review of medical oncology services.

That’s the view of Calvary Mater Newcastle director of oncology services Dr Tony Bonaventura, who said yesterday that the $1million worth of improvements agreed to by health authorities were only the start of what was needed.

A review of medical oncology services made public on Friday vindicated the concerns of Dr Bonaventura and others who spoke out a year ago about shortcomings with the services.

The cost of bringing Hunter and New England medical oncology into line with modern standards has been put at about $10million a year.

But a spokeswoman for the Hunter New England Local Health District said the oncology improvements would have to be paid for out of the organisation’s existing budget.

This was confirmed by a spokeswoman for Health Minister Jillian Skinner, who said the cost of the improvements was ‘‘a matter for the local health district’’.

Wallsend Labor MP Sonia Hornery said the government needed to find extra funding for the Hunter, otherwise the health service would have to ‘‘rob Peter to pay Paul’’.

‘‘The review found the service was short-staffed and that people were working under great duress,’’ Ms Hornery said.

‘‘Before the election, Ms Skinner made a big show of concern about this and now that she’s minister she should be demonstrating that concern by funding the solution.’’

Dr Bonaventura said Hunter New England Health and the Mater had found $400,000 for nursing salaries to operate four more oncology chairs, taking the total from 12 to 16, with another four chairs dedicated to clinical trials.

Dr Bonaventura said $600,000 a year had been found to employ a full-time medical oncologist at Manning Hospital at Taree.

But there was no money for the four medical oncology specialists recommended by the review, and any extra money to oncology would logically have to come from another part of the area health budget.

Already overcrowded public hospital birthing units will struggle to cope with the stream of new patients forced out of the private system if the private health insurance rebate is means tested, obstetricians fear.

The number of expectant and new mothers in public hospitals already has increased since the federal government cut the Extended Medicare Safety Net for Obstetrics in 2009, according to the National Association of Specialist Obstetricians and Gynaecologists.

"We have seen a significant shift (7 per cent-20 per cent) of pregnant women moving to public hospitals since government cut the obstetrics rebate from 80 per cent to 20 per cent of their out-of-pocket expenses," NASOG president Andrew Foote said.

The organisation has initiated separate petitions to coerce the government to reinstate the safety net value and axe it's rebate plans.

Australian Medical Association WA president Dave Mountain said a baby boom in WA during the past five to 10 years had exacerbated the problem in this state.

"[A means tested private health insurance rebate] would be a major problem."

WA's birth rate has grown from 1.7 births per 100,000 women in 2002 to 2.1 in 2008, although there was a decline in 2009, according to the Australian Bureau of Statistics.

Dr Mountain said the influx of new residents to the state was mostly people working in the mining and related industries, which paid wages above the intended rebate threshold.

They also were of reproductive age.

"We don't know exactly what [means testing the rebate] is going to do ... but there will definitely be some increased pressure on the public system and it might be quite dramatic," Dr Mountain said.

The federal government is likely to be successful is its bid to means test the 30 per cent private health insurance rebate and, at the same time, increase the Medicare levy surcharge for those without cover.

The means test would kick in for individuals earning more than $83,000 and families earning more than $160,000.

Opponents claim reducing the rebate would make private health insurance unviable for many, pushing them back into the public system and causing premiums for those remaining to rise as insurers sought to cover their costs among fewer clients.

Private patients are generally entitled to one obstetrician for the duration of their pregnancy, are guaranteed their own room while in hospital and can usually spend longer in hospital before being discharged.

"The public system makes a very good standard of care but private buys you the peace of mind that you have got an obstetrician available to you all the time," Dr Mountain said.

Expectant mother Michelle Whitehead, from Padbury in Perth's north, said she already did not believe she was getting value for money with her private health insurance and would consider cancelling it if the rebate became means tested.

Mrs Whitehead, 33, had her first child, son Lachlan, 2, in the public system but took out private health insurance shortly after he was born to provide greater choice in her treatment for the second baby.

She is paying more than $60 per fortnight for the cover and would be subject to the proposed means test.

"Every parent is a bit nervous about not having the cover when there's children involved [but] if it's going to be going [up] I'd definitely look into how much out of pocket we would be and whether it was worth it," Mrs Whitehead said.

"We're all very healthy, the only thing we'll be claiming is having the baby and it's a lot of money when it would be free if you didn't have private [health insurance]."

Bunbury journalist Lee-Maree Gallo is forking out more than $75 per fortnight to ensure she can have her first baby, due in June, in the private system.

However, after already cutting back her cover due to the cost, she would seriously consider cancelling it all together if the means tested rebate affected her premium.

"For my second I would definitely consider not having it [in the private system] because it's really expensive," Ms Gallo, 29, said.

"Sometimes you think in the long run it's better to put away money each week and if something happens we've got the money there.

NEW YORK — A government panel favors expanding an aid program for people sickened by World Trade Center dust to include people who have at least some types of cancer.

Congress has set aside billions of dollars to compensate and treat people suffering from illnesses potentially caused by the clouds of soot and smoke released on 9/11.

But the program doesn't cover cancer, which scientists have yet to conclusively link to trade center toxins.

Members of an advisory panel meeting in New York agreed Thursday that some cancer patients should be covered by the program, but they were uncertain whether to extend it to all types of the disease or just some.

The committee's recommendation is due by March 2. Its advice can then either be accepted or rejected by the program's administrator.

Fears over vials of fake drugs reaching stricken cancer patients are renewing scrutiny of the US pharmaceutical supply chain and raising concerns that shortages and the high cost of medicines are giving counterfeiters new opportunities.

Earlier this week, Roche, the Swiss drug maker, said counterfeit versions of Avastin, its top-selling cancer drug, were being circulated in the US and putting patients at risk.

The fake version of Avastin, which is approved in the US to treat colon, lung, kidney and brain cancers, had no active ingredients and the US Food and Drug Administration alerted 19 medical centres about purchases made from a questionable distributor.

The FDA, which was tipped off to the problem in December by the UK’s Medicines and Healthcare Products Regulatory Agency (MHRA), said its investigation is ongoing. The incident was foreshadowed last month when the US regulator issued a warning about unapproved medications.

“Current shortages of injectable cancer medications may present an opportunity for unscrupulous individuals to introduce non-FDA approved products into the drug supply, which could result in serious harm to patients,” the FDA said in January.

Counterfeit drugs are a growing problem around the world and have become increasingly prevalent in the US, as more manufacturing moves overseas and illicit online drug stores proliferate. The black market for fake drugs generated $75bn in revenues in 2010 and pharmaceutical supply experts argue that rising costs of some drugs, along with medical practitioners cutting corners, are leaving patients more vulnerable to fakes.

“People have determined that the US is susceptible because there are so many drug shortages,” said Pat Earl, chief executive of the Secure Pharma Distributor Network, a group of small drug distributors. “Everyone is trying to fill gaps.”

The US is suffering from a severe shortage of generic injectable drugs, which is raising the price of name-brand products and forcing hospitals and medical practices to seek products in secondary markets from smaller distributors. According to the National Association of Boards of Pharmacy, up to 2 per cent of prescription drugs in North America are fake and sales of counterfeit drugs are growing by 13 per cent year-on-year, outpacing sales of legitimate drugs.

Although the FDA said that there is not an Avastin shortage, Ms Earl suggests that the drug could have been sought as an alternative for a drug in short supply.

The US supply chain has been relatively secure compared with other parts of the world, says Thomas Kubic, president of the Pharmaceutical Security Institute, who suggested that the “closed system” that has protected customers is being compromised by aggressive pitching from fraudulent drug reps and web sites peddling fake products.

The US has been considering legislation to tighten its controls over the drug supply with “track and trace” technology and creating more uniform regulations across states, but critics complain that existing rules remain muddled.

According to Nathan Sigworth, chief executive of PharmaSecure, the fake Avastin is another example of a problem that has been widespread in developing countries becoming more pervasive in mature markets.

“People will always seek to find alternative ways of getting inexpensive drugs,” Mr Sigworth said. “The real focus needs to be on doing something at the source that allows people to understand where drugs are coming from and if they are authentic.”

PharmaSecure works with drug companies in India to put serial numbers on drug packaging, which consumers can then authenticate using computers or mobile phones.

“Companies in the US have been waiting for government regulation standardising track and trace standards mandating registration of products at every point in the supply chain, but companies and consumers should not wait,” Mr Sigworth said.

Roche says: “We only sell our products directly to a defined number of fully licensed and contracted wholesalers and specialty distributors.”

Occasionally fake drugs do enter the legitimate supply chain, such as in the UK in 2007, when batches of three drugs including a cancer treatment were discovered. That has boosted efforts by the pharmaceutical industry and policymakers alike to toughen standards.

Their efforts have focused on controls on drug distributors, as well as tougher identity codes on individual medicine packets. A variety of companies are promoting different systems to ensure pharmacists can scan and trace boxes to verify swiftly with a central system when the code is suspicious.

In spite of new safeguard technology, some analysts say securing the supply chain is a matter of ethics.

Adam Fein, a drug company consultant, said it should have been easy for medical practices to determine that the fake Avastin they were purchasing was not from an approved distributor and that the French writing on the packaging was an obvious cause for doubt.

Mr Fein suggested that the buyers were being greedy by purchasing the drug, which normally sells for $2,400 a vial, at a deep discount. “Certainly it appears the motivation was financial,” he said.

COMPANIES do not have the right to a patent over human gene sequences and genetic mutations because such biological material is a product of nature, a court has been told.

The patient advocacy group Cancer Voices has launched landmark legal action against two biotechnology companies that hold patents over a genetic mutation linked to breast and ovarian cancer, known as BRCA1.

The Federal Court has been asked for the first time to decide if patents granted over segments of human DNA are valid.

The US biotech company Myriad Genetics and the exclusive Australian licensee, Genetic Technologies, have a monopoly right to control the use of the BRCA1 mutation for research and development as well as diagnostic testing.

It was granted on the basis that the process of isolating the gene from the human body in a laboratory constituted an "invention".

In 2008, Genetic Technologies threatened to invoke its patent by ordering all other laboratories to stop performing BRCA1 diagnostic testing but withdrew after a public backlash. The patent is enforced in the US.

Rebecca Gilsenan, from Maurice Blackburn lawyers, which is running the case pro bono, said isolating a gene from the human body cannot amount to a patentable invention, as it is merely a ''discovery''.

Under Australian law, patents can only be granted over "inventions" which constitute a "manner of manufacture" or "manner of new manufacture".

The court will have to decide whether a naturally occurring biological material when isolated from its natural environment is a ''manner of manufacture''.

Ms Gilsenan said the plaintiffs would argue there were no material structural or functional differences between a BRCA1 gene that is inside the body and a BRCA1 gene that has been isolated from the body.

However, David Shavin, QC, for Myriad, told the court that when removed from the body and used to predict a person's predisposition to breast or ovarian cancer, the isolated nucleic acid is, in fact, different to that which exists in the cell.

''We are not seeking to patent the BRACA1 gene,'' he said. ''The thing that has been created and isolated … is an artificially constructed state of affairs.''

''More and more research is leading to the genetic diagnosis of cancer,'' the group's executive director, John Stubbs, said outside court. ''They are our genes, we want to make sure they and the diagnostic tests that go along with them are protected.''

The second applicant, breast cancer survivor Yvonne D'Arcy, said she has taken legal action as she believes biological material should not be used for profit.

''If you're really sick and its a genetic form of cancer, then everyone female down the line should be able to get the testing done at a price they can afford and if its patented, it won't be,'' she said.

In 2010, a US District Court ruled the same patent was invalid, but the decision was overturned on appeal last year. The American Council for Civil Liberties has petitioned the US Supreme Court to review the decision.

The hearing before Justice John Nicholas is expected to last up to eight days.

INTERNATIONAL researchers have identified another genetic mutation linked to breast cancer in families.

Writing today in the journal Science Translational Medicine, the team from the US and Finland reports that a mutation in the Abraxas gene interacts with the well-known breast cancer gene BRCA1 to impair repair of damaged DNA.

"Accurate DNA repair is critical to maintain the genome and prevent breast cancer susceptibility," said team co-leader Roger Greenberg, a biologist with the University of Pennsylvania.

In a twist, the discovery - obtained by genetic screening of 125 Finnish families with breast and ovarian cancer - comes as, on Monday, Australia's first gene patent test case began in the Federal Court in Sydney.

In that case, advocacy group Cancer Voices Australia and 65-year-old Brisbane breast cancer survivor Yvonne D'Arcy are asking the court to rule that a patent on the cancer-promoting version of BRCA1 - patented in 1994 by US firm Myriad Genetics - be invalidated on the grounds that a mutation is a discovery, not an invention.

Similarly, the US Supreme Court on Tuesday delayed a decision on whether it would hear an appeal from a lower court ruling in favour of Myriad Genetics. Last year the Federal Circuit Court found that once a gene was removed from the body and separated from nearby genetic material it was patentable.

Opponents of Myriad Genetics' patents on the BRCA1 gene variant - and a second, BRCA2 - argue the patents hinder research and increase the cost of diagnostic testing. Professor Greenberg declined to comment on the litigation, explaining "it's beyond my expertise".

According to Ian Olver, chief of Cancer Council Australia, the finding highlights the need to determine if genes are patentable. "Although we know about BRCA1 and BRCA2, they account for at most about 20 per cent of familial breast cancers. It appears there will be more potentially useful genes discovered."

Feb. 23 (Bloomberg) -- Two years ago, Robert Rapoport, a radiologist in Albany, New York, spent about $1 million to replace a 10-year-old open MRI machine, the only one available within a 30-minute drive.

It’s an expense his imaging centers wouldn’t be able to recoup today, he says.

Rapoport, reeling from the effects of $6 billion in federal reimbursement reductions since 2007, says he’s reached the point where he can’t buy equipment for his patients that will be more effective or safer without taking a loss. And this year, he faces a new ruling: The U.S. has set a limit on how much it will pay for more than one scan per patient in a day.

Regulators say the reductions ensure that testing is efficient and necessary. Doctors, though, are pushing a lobbying effort in Washington to peel the cuts back, saying they’ve forced centers to close, limiting how many MRI’s and CT scans are available to cancer patients and trauma victims, particularly in underserved rural areas.

“There will be extreme delays for procedures, delays that could mean a removable mass turns into an incurable cancer,” Rapoport, 47, said in a telephone interview.

Since Jan. 2007, the number of mammography centers in the U.S. has shrunk by 209 to 8,624 on Feb. 1, leaving 1,319 fewer breast cancer scanners in place, according to U.S. data. While the U.S. doesn’t track data on how many facilities have MRI’s and CT scanners, radiologists such as Rapaport say the data reflects what’s happened with all imaging centers.

2007 Change

Reimbursement for imaging centers first became an issue after Medicare spending on the services almost doubled to $13.7 billion between 2000 and 2005. That spurt prompted concern by Medicare officials and U.S. legislators that doctors who owned the equipment, and many of the centers, were doing unnecessary medical scans to boost their profits.

In reaction, the 2005 Deficit Reduction Act trimmed Medicare spending for imaging by $1.7 billion, or 12.5 percent, to $12 billion, starting in 2007. Since then, successive congresses have reduced the amount further and by 2010, reimbursement levels for Medicare spending had fallen to $11.5 billion, the lowest since 2003, according to the Centers for Medicare and Medicaid Services.

Now, radiologists and their Washington-based trade groups are pushing back. They’ve enlisted the backing of 196 U.S. House members for legislation introduced by Representatives Pete Olson, a Texas Republican, and Betty McCollum, a Minnesota Democrat, that would undo the January policy limiting multiple same-day scans while requiring independent cost analysis using a method defined by radiologists to justify any further reimbursement reductions.

Patient Welfare

The cascading cuts shouldered by radiologists since 2007 do more than punish doctors for possible excesses, said Sandra Schneider, a radiologist in Rochester, New York. They are negatively affecting the welfare of patients, particularly those in rural areas, she said.

“We rely on CMS and other agencies to do these measures in the best interest of patient care, not on payment,” said Schneider, formerly the president of the American College of Emergency Physicians. “They’re doing everything they can to show they’re cutting costs without looking at the unintended consequences downstream.”

Government measures to identify what services are inappropriate also are under fire. A new efficiency measure developed by CMS to reduce CT scans in emergency rooms was only 17 percent accurate in assessing which patients should get a scan, according to a study published today in Annals of Emergency Medicine.

Health-Care Spending

Health-care spending in the U.S. reached almost $2.6 trillion in 2010, more than ten times the $256 billion spent in 1980, according to CMS. By 2019, national health spending is expected to reach $4.5 trillion and comprise 19.3 percent of GDP, the center said.

Starting this year, CMS will cut doctors reimbursements by 25 percent each time a Medicare patient undergoes more than one scan in a given day. The policy would save about $100 million that the government wants to use to beef up reimbursements for primary care and other medical services, according to CMS.

The rule may discourage doctors from treating patients after serious accidents or strokes, or limit options for cancer patients whose disease has spread, Schneider said. Such cases may require scans on several parts of the body or repeat imaging to confirm a diagnosis, she said.

Trauma Patient

“The most obvious is a trauma patient who breaks bones in the face and body,” Schneider said. “They’re going to be pushing to not do both studies on the same day.”

Medicare says radiologists can be more efficient, and that limiting payments ensures that more tests are only done when needed.

Doctors say the policy is unfair and doesn’t take into account processing time. Rapaport cites the example of a patient with brain and chest injuries who may need 100 images of each body part. It may take two doctors with different specialties to pore over the data, and it doesn’t make sense for the second physician will be paid less, he said.

In 2006, Herb Kuhn, who was director of the Center for Medicare Management at the time, said the initial cuts were included in the 2005 Deficit Reduction Act because the previous rates provided “inappropriate incentives for growth in volume and intensity of services with limited clinical benefit.”

From 2009 to 2010, as the cuts were rolled out, the volume of imaging services decreased by 2.5 percent, according to CMS.

Skewed Incentives

The old fee schedule “got skewed in favor of specialty services,” said Judith Feder, a fellow at Washington-based Urban Institute, which analyzes social and economic policy.

“Now the schedule needs to be rebalanced,” said Feder, who is also a professor of public policy at Georgetown University in Washington. “We need to reinvest appropriately in primary care as we work to be more efficient and mindful in the way we’re paying specialists.”

The cuts are prompting radiologists to close practices or take hospital jobs, creating gaps in coverage in outlying areas, said Bibb Allen, chairman of the American College of Radiology Economics Commission. Hospitals are reimbursed more for imaging work than the private practices, meaning CMS may end up paying more per patient over the long run, he said.

‘More Expensive Venue’

“In their zeal to try to reduce payments for imaging in the physician fee schedule, they’re really just pushing that work over to a more expensive venue,” Allen said.

The radiologists reference a 2009 study by the National Bureau of Economic Research, showing increased use of imaging is linked with longer life expectancies. A January report in Annals of Emergency Medicine said head injury patients treated with blood thinners to prevent clots should be CT scanned twice in a 24-hour period before they are discharged, to check for delayed hemorrhages.

“Every year we’ve fought one more battle against payment reduction,” Allen said. “We’ve been asked to make an apology for a very valuable tool in the health care enterprise.”

Government advice to patients and doctors on the safety of medical devices - including critical implants such as pacemakers - is inadequate and inconsistent, and does not reflect the seriousness of the damage they may cause, says a Sydney researcher.

''Reporting of incidents involving medical devices has become more frequent but most reports are not investigated or, after investigation, no action is taken,'' said Richard McGee, a researcher at the University of Sydney school of public health.

Dr McGee analysed alerts and statistics published on the website of the Therapeutic Goods Administration between 2000 and 2011, finding the agency had attributed 295 deaths and 2357 serious injuries to medical devices during that time.

Advertisement: Story continues below But there were long periods for which no data was published. No information was available beyond 2009, though the number of uninvestigated incidents rose sharply in that year.

Dr McGee, whose analysis follows this year's scandal over the high rupture rate of French-made PIP breast implants, said he had been unable to determine whether this was ''a random variation or the beginning of an increasing trend''.

It was also not clear among the uninvestigated reports how many related to implants such as joint prostheses or heart devices, or pieces of equipment such as dressings which were used externally and less likely to cause serious health consequences.

Dr McGee, whose study is published today in the Medical Journal of Australia, said he had intentionally analysed only information in the public domain ''because we wanted to maintain the perspective of the average health care worker or informed consumer''.

While the agency had announced plans to improve its public reporting, Dr McGee said none of the proposals ''address the issues we have raised, namely missing and conflicting data, the increasing proportion of uninvestigated reports and a lack of information about the type of medical devices being recalled''.

A spokeswoman for the Therapeutic Goods Administration said it had committed in December to ''changing the way it communicates and engages with the community, and also to changing the framework for regulating medical devices''.

This would include ''increasing the rigour of pre-market regulatory assessment of higher risk medical devices''. The agency would also open its internal database on device accidents to make it searchable by the public.

"It's worrying to see just how far behind NSW sun protection measures are compared to other states," she said in a statement on Sunday.

As part of the survey, each state and territory was marked on a list of key sun protection requirements, such as wearing a sun safe hat and using SPF 30+ sunscreen.

Queensland, the Northern Territory, Victoria and the ACT all scored top marks while Tasmania, which has much lower levels of UV radiation, came in at the bottom of the list.

Principals in NSW were found to be following a government sun protection policy introduced in 1997.

"We are asking the government to update the current policy as a matter of urgency to bring us in line with other states," Ms Rock said.

"We know that overexposure to UV radiation in childhood increases the risk of developing skin cancer as an adult.

"It is vital that children are well protected in these important years."

But Ms Rock is urging schools not to wait for an official new sun protection policy to be implemented.

"State schools across NSW can still make a real difference by implementing some simple measures such as mandating a sun safe hat (and not a baseball cap) as part of the school uniform and encouraging children to use sunscreen before going outside," she said.

A GROUNDBREAKING trial gets underway in Montreal today against three leading tobacco companies which face a $25 billion lawsuit for allegedly failing to adequately warn smokers of the dangers of cigarettes.

Plaintiffs have filed two separate class actions in what is Canada's biggest-ever civilian lawsuit, against Imperial Tobacco, JTI-Macdonald and Rothmans Benson & Hedges in the Superior Court of Quebec.

The first class includes 90,000 current and former smokers in Quebec who say they have fallen ill with a range of smoking-related ailments including emphysema and cancer of the throat and larynx, and are seeking $105,000 Canadian per person.

The second suit was filed by 1.8 million current smokers who say they are unable to quit the tobacco habit, and are seeking $10,000 per person.

According to court documents, the plaintiffs accuse the Canadian tobacco companies of hiding research which has established a link between smoking and serious health problems like cancer.

The suit also alleges that tobacco firms in Canada have tried to manipulate the levels of nicotine in their cigarettes, increasing the levels of dangerous tar and have also added certain products such as ammonia.

Mario Bujold, director general of the Quebec Council on Tobacco and Health said told AFP that one of the witnesses will be Robert Proctor, author "Golden Holocaust" of a book alleged nefarious practices by the US tobacco industry.

Quebec is only one of several Canadian provinces seeking monetary damages from the tobacco manufacturers.

Several provinces, led by British Columbia, are also suing Canada's tobacco companies in hopes of recovering billions of dollars spent by their health insurers to treat the victims of tobacco use.

MORE than 2.4 million health fund members will pay up to $1300 a year more for health cover from July after Labor's means test on private health fund subsidies was approved by the Senate last night.

The measure will save the government $746.3 million in 2012-13 and is worth half the government's projected $1.5 billion budget surplus.

It was third time lucky for the government, which has been trying to get parliamentary approval for the budget cut since 2009, rejected twice before by the Senate.

To secure the support of the Greens, the government had to pledge to spend $165m raised from the changes on public dental care. Health Minister Tanya Plibersek said the legislation was "a win for low- and middle-income earners, who have been forced to subsidise the private health insurance of higher-income earners through their taxes."

Tony Abbott has pledged to repeal the means test "as soon as we can" in government but has not said how he would find the $2.4bn required for this promise.

The Opposition Leader said yesterday the measure was "the latest instalment in this government's attack on middle Australia.

"You've got the carbon tax, you've got the means test on things like the Baby Bonus, you've got the coming schools hit list, and today the government is seeking to attack middle Australia by putting the private health means test on 2 1/2 million Australians."

Chris Rex, the chief of one of the country's largest private hospital groups, Ramsay Health Care, has warned that the measure was likely to see people cut back on their health cover, which would affect the viability of his 13 rural hospitals.

Michael Armitage, the chief of health fund lobby group Private Healthcare Australia, said means-testing the 30 per cent rebate "will force people out of the private healthcare sector and into the public system, and it will force premiums up for those who remain in private cover".

"More than half of the Australian population has some form of private health cover and they don't think they're rich," he said.

The means test will reduce the 30 per cent private health insurance rebate paid to families earning more than about $166,000 a year and to singles on more than about $83,000.

MEDICARE and Centrelink take so long to answer their phones that clients are falling asleep on hold, a survey has revealed.

And those who work for the two government agencies face-to-face with the public say they fear for their own safety as violence escalates.

A workplace survey by the Commonwealth Public Service Union has found federal Budget cuts on the Department of Human Services, combined with an increased workload from the floods, have limited the ability of staff to serve customers.

The survey of almost 1000 workers in 69 agencies across Centrelink, Medicare and Child Services, found stress and wait times had blown out, with staff not being replaced. And those remaining were unable to manage the load.

One manager said the stress contributed to him having a heart attack.

Staff were increasingly requesting security guards at the service agencies, the survey found.

"One (customer) threatened to come back and burn me," a staff member wrote.

"I fear we will break sooner rather than later, or the customers will - and we could have a dangerous event that threatens staff or customer safety - it is only a matter of time," wrote another.

Call centre staff reported two instances of answering calls "only to find the customer had been waiting so long they had fallen asleep".

"They were snoring," the staff member wrote.

The snoring matters were referred to a Canberra boss, who said the call should be terminated after 30 seconds if the customer does not wake.

"This looks good on the stats because it is a short call, and it appears that we are processing more customers," the staff member reported.

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